Who Should Not Take Hormone Replacement Therapy (HRT)?

For many women, hormone replacement therapy (HRT) can offer relief when managing hormonal imbalance, especially during perimenopause and menopause.

While HRT can be a safe and effective treatment, it is not one-size-fits-all. Women with history of hormone-sensitive cancers, uncontrolled hypertension, a heart condition, kidney and liver disease may not be good candidates for HRT.

If you are struggling with symptoms like hot flashes or low libido, there are other options available.

So, who should avoid HRT, and what other options are available?

Let’s break it down.

What is Hormone Replacement Therapy?

As women approach perimenopause or menopause, symptoms like hot flashes and low libido can appear. This happens because the body is not making enough hormones like it used to. In fact, estrogen levels drop by 67% during the four years surrounding menopause.

That’s where HRT comes in.

Hormone replacement therapy replaces the hormones that your body is not making enough of whether it is estrogen, progesterone, or testosterone. This can help reduce symptoms of low libido, night sweats, hot flashes, and improve overall quality of life.

Benefits of HRT

• Better sleep
• Reduces hot flashes & night sweats
• Increases energy
• Mental clarity
• Supports bone health

Potential Risks

• Irregular bleeding or spotting
• Breast tenderness
• Moodiness
• Bloating

Who Should Not Take HRT?

While HRT can offer real relief for many women, it is not a one-size-fits-all. Recent changes to the FDA’s labeling for HRT have removed the boxed warning about risks such as cardiovascular disease, breast cancer, and dementia. However, HRT still has risks and may not be right for everyone.

 Certain conditions and factors can make hormone replacement therapy unsafe, including:

History of certain cancers

What: A history of breast cancer or gynecological cancers that are affected by hormones, including ovarian, uterine, and endometrial.

Why: Some of these cancers respond to hormones like estrogen and progesterone. For those with hormone-sensitive cancers, HRT can increase the risk of cancer returning and negatively affect cancer treatments.

Uncontrolled blood pressure or certain heart conditions

What: Uncontrolled blood pressure or certain heart conditions.

Why: Depending on your individual health history, HRT may increase certain cardiovascular risks, including the risk of blood clots.

If your blood pressure is brought under control, talk with your provider about whether HRT may be an option for you.

Liver disease

What: Liver disease, particularly when considering oral estrogen.

Why: Oral estrogen is processes through the liver.

Other forms of HRT, such as patches and gels, get absorbed through the bloodstream rather than the liver. Talk to your provider about whether transdermal HRT could be an option.

Kidney disease

What: Kidney disease.

Why: While HRT is not strictly forbidden for women with kidney disease, it does require careful consideration based on your overall health and individual risk factors.

A provider can review your health history and potential risks to determine if HRT is right for you.

Alternatives to HRT

HRT isn’t the only way to manage menopause symptoms. Whether you’re looking for something nonhormonal or simply want to explore what’s available, there are several options worth considering, including:

Lifestyle changes

Creating a regular exercise routine can help manage symptoms like hot flashes, stress, anxiety, and even improve sleep. And it doesn’t have to be running. Walking, yoga, dancing, and aerobics are great ways to manage symptoms.

Diet

What you eat can play a role in how you feel during menopause. A balanced diet that includes foods rich in omega-3 fatty acids and vitamins can help manage menopause symptoms. Some options to add to your meals include:

• Seed oils
• Avocado
• Lentils
• Garlic
• Meat
• Fish

Some also find that limiting spicy foods, caffeine, and alcohol can help reduce certain symptoms like hot flashes and unrestful sleep.

Vaginal lubricants & moisturizer

Vaginal dryness is a common symptom of menopause, causing discomfort during sex. Non-hormonal vaginal moisturizers and lubricants can provide relief without the need for HRT.

Antidepressants (SSRIs)

SSRIs like paroxetine, escitalopram, and citalopram, may help reduce hot flashes, night sweats, and mood swings. While they may cause side effects like dry mouth, they are generally a safe alternative to HRT.

Is HRT Right for You?

Wondering if HRT is right for you? The best way to find out is to look at your symptoms, hormone levels, health history, and overall health goals.

At SynergenX, our board-certified providers and care teams are here to help you understand your options and decide whether HRT fits into your health journey.

Ready to live your best? Book or call an appointment today.

Sources:

Hormone Replacement Therapy (HRT) for Menopause

Estradiol Rates of Change in Relation to the Final Menstrual Period in a Population-Based Cohort of Women – PMC

What to Know About Hormone Replacement Therapy (HRT) and Cancer Risk | American Cancer Society

Cardiovascular Risk Associated with Menopause and Menopause Hormone Therapy: A Review and Contemporary Approach to Risk Assessment – PMC

HHS Advances Women’s Health, Removes Misleading FDA Warnings on Hormone Replacement Therapy | FDA

The 2023 nonhormone therapy position statement of The North American Menopause Society – PubMed

Medically reviewed by: Micheal Seay, MSN, APRN, FNP-BC

Michael Seay is a Board-Certified Family Nurse Practitioner (FNP-BC) with over 16 years of clinical experience in emergency medicine, urgent care, gastroenterology, geriatric care, and hormone optimization therapy for men and women. He holds a Master of Science in Nursing from Walden University and a Bachelor of Science in Nursing from Platt College School of Nursing. He is certified in hormone pellet placement and weight loss therapies, with a clinical focus on individualized, patient-centered care.